Subsequent pregnancy in women with prior peripartum cardiomyopathy: the prognostic role of baseline LVEF
N Shamsieva, S T Mirzarakhimova, I A Soy, T A AbdullayevAbstract
Background/Introduction
Subsequent pregnancy (SP) in women with a history of peripartum cardiomyopathy (PPCM) poses a major clinical challenge due to the risk of relapse of left ventricular (LV) dysfunction, heart failure (HF) deterioration, and maternal mortality. While recovery of left ventricular ejection fraction (LVEF) is generally considered a favorable prognostic marker, its predictive value for outcomes in subsequent pregnancies remains controversial and is addressed in current ESC guidelines on cardiovascular diseases during pregnancy.
Purpose
To evaluate the impact of subsequent pregnancy on clinical course and maternal outcomes in women with prior PPCM, with a focus on the prognostic significance of pre-pregnancy (baseline) LVEF.
Methods
From 1998 to 2023, 130 women with PPCM were followed at a tertiary cardiology center in Uzbekistan. Of these, 11 women proceeded with subsequent pregnancy despite counseling. Patients were stratified into two groups based on pre-pregnancy LVEF: Group 1 – LVEF <50% (n=8); Group 2 – LVEF ≥50% (n=3). Assessments included NYHA class, echocardiographic parameters, NT-proBNP levels, and maternal outcomes before, during, and after pregnancy. Key adverse outcomes were HF progression, LVEF decline below 30%, and mortality.
Results
Adverse maternal outcomes were significantly more frequent in Group 1 (persistent LV dysfunction). One maternal death occurred in a patient with severely reduced LVEF (<30%) and marked LV dilatation. Four patients (50%) developed progressive HF with LVEF decline below 30%, often accompanied by fetal loss. Three women remained in NYHA II–III under close monitoring and beta-blocker therapy, with successful deliveries. In contrast, all women in Group 2 (recovered LVEF ≥50%) remained clinically stable throughout pregnancy, with no significant LVEF decline and successful deliveries in all cases. Illustrative cases showed post-partum LVEF deterioration from 43% to 28% with NT-proBNP rise (311 to 3562 pg/mL) in incomplete recovery, versus preserved function (61%) in normalized LVEF.
Conclusion(s)
Baseline LVEF is a major predictor of maternal outcomes in subsequent pregnancy following PPCM. Persistent LV dysfunction (LVEF <50%) is associated with high risk of HF progression, severe deterioration, and mortality. Women with recovered LVEF ≥50% generally have favorable outcomes, but careful multidisciplinary monitoring remains essential even in this group, in line with ESC recommendations. These findings from a Central Asian cohort highlight the need for individualized preconception counseling and risk stratification.